Impact Of Hiv On The Diagnosis Of Tb In Children

HIV makes the diagnosis and management of TB in children even more difficult than usual, for the following reasons:

a) Several HIV-related diseases, including TB, may present in a similar way (see section 4.8 for differential diagnosis).

b) The interpretation of tuberculin skin testing is less reliable. An immunocompromised child may have a negative tuberculin skin test despite having TB.

c) In some countries HIV infection is very common in adults with TB. If there is a history of contact with an adult with smear-positive PTB and that adult is the child's parent, then the child has an increased chance of being HIV infected as well. In addition, the child with TB, even if not HIV-infected, may come from a household where one or both parents have died. This situation makes compliance and completion of treatment more difficult.

For these reasons and those mentioned above, many of the clinical features that are used to suggest a diagnosis of childhood TB are less useful in the presence of HIV infection.

Impact of HIV infection on the usefulness of features used to diagnose PTB in children

Diagnostic feature

Impact of HIV

Chronic symptoms

less specific

Smear-positive contact (if parent)

less specific

Malnutrition or failure to thrive

less specific

Positive tuberculin test

less sensitive

"Characteristic" CXR abnormalities

less specific

Satisfactory response to TB treatment

less sensitive

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